Provider Demographics
NPI:1467696294
Name:VELASCO, JELENE M (LMT)
Entity Type:Individual
Prefix:MS
First Name:JELENE
Middle Name:M
Last Name:VELASCO
Suffix:
Gender:F
Credentials:LMT
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Mailing Address - Street 1:2822 SOMERSET PARK DR
Mailing Address - Street 2:UNIT #203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3244
Mailing Address - Country:US
Mailing Address - Phone:813-431-6095
Mailing Address - Fax:
Practice Address - Street 1:6301 MEMORIAL HWY
Practice Address - Street 2:STE 304
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4573
Practice Address - Country:US
Practice Address - Phone:813-374-9923
Practice Address - Fax:813-374-9922
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMA#54379111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation